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361P A RETROSPECTIVE ANALYSIS OF PLATINUM-BASED<br />
NEOADJUVANT CHEMOTHERAPY FOR LOCAL ADVANCED<br />
TRIPLE NEGATIVE BREAST CANCER<br />
F. Fei, Y. Du, X. Gu, C. Chen, J. Wu, Z. Shao<br />
Breast Surgery, Shanghai Cancer Center Fudan University, Shanghai, CHINA<br />
Purpose: We retrospectively analyzed platinum-based neoadjuvant chemo<strong>the</strong>rapy for<br />
LATNBC to compare survival outcomes between patients with PCR and with<br />
non-PCR. Fur<strong>the</strong>rmore, <strong>the</strong> disease free survival of LATNBC patients with PCR<br />
continuously receiving primary regimen as adjuvant setting had comparative<br />
advantage concerning that of “PCR” patients switching to o<strong>the</strong>r regimens as adjuvant<br />
setting as well as those without any chemo<strong>the</strong>rapy after sugery.<br />
Patients and methods: 124 women with stage II or III TNBCs experienced<br />
platinum-based regimens as neoadjuvant chemo<strong>the</strong>rapy from Nov 1, 2007 to Dec 31,<br />
2011. All patients were divided into <strong>the</strong> two groups, who were with and without PCR<br />
in <strong>the</strong> pathological reports after surgery. According to <strong>the</strong> adjuvant settings for<br />
LATNBC patients with PCR, <strong>the</strong> three arms were determined as continuous primary<br />
regimen (<strong>the</strong> same as neoadjuvant) arm, no more chemo<strong>the</strong>rapy arm and switching<br />
arm. Disease free survival was computed using <strong>the</strong> Kaplan-Meier product limit<br />
method.<br />
Result: We presented a retrospective chart review of 124 LATNBC patients who<br />
underwent platinum-based neoadjuvant chemo<strong>the</strong>rapy in our hospital. Fifty (40.32%)<br />
of those patients receiving neoadjuvant chemo<strong>the</strong>rapy had PCR when <strong>the</strong>y<br />
underwent surgery. After controlling for covariates associated with survival, patients<br />
undergoing neoadjuvant chemo<strong>the</strong>rapy with residual tumor had significantly worse<br />
survival than patients with PCR (HR = 0.37,P < 0.05). Of 50 patients with PCR<br />
confirmed by surgery, <strong>the</strong> disease free survival of 24 cases switching to o<strong>the</strong>r<br />
regimens in <strong>the</strong> adjuvant setting was significantly better than that of 24 cases<br />
continuously receving primary regimens in <strong>the</strong> adjuvant setting (HR= 0.51, P =<br />
0.025)and that of 2 cases with no more chemo<strong>the</strong>rapy(HR= 0.58, P = 0.017)<br />
Conclusion: Patients with PCR had statistically significantly better clinical survival<br />
than those with non-PCR after platinum-based neoadjuvant settings.So far, if<br />
LATNBC patients with PCR after platinum-based neoadjuvant chemo<strong>the</strong>rapy, <strong>the</strong>y<br />
might have better clinical survival if <strong>the</strong>y receive switching regimens than to receive<br />
primary regimens and to continue with no additional chemo<strong>the</strong>rapy after surgery. A<br />
randomized prospective study needs to be carried out to streng<strong>the</strong>n <strong>the</strong> results<br />
because of statistical bias.<br />
Disclosure: All authors have declared no conflicts of interest.<br />
362P MIGHT EARLY METABOLIC RESPONSE BY 18F-FDG-PET/CT<br />
BE USEFUL TO SELECT PATIENTS (PTS) WITH BREAST<br />
CANCER (BC) WHO WILL NOT OPTIMALLY RESPOND TO<br />
PREOPERATIVE CHEMOTHERAPY (PCT)?<br />
G. Zucchini1 , S. Quercia1 , C. Zamagni1 , D. Santini2 , M. Taffurelli3 , S. Fanti4 ,A.<br />
A. Martoni1 1<br />
Medical Oncology Unit, S. Orsola-Malpighi University Hospital, Bologna, ITALY,<br />
2 3<br />
Pathology Unit, S. Orsola-Malpighi University Hospital, Bologna, ITALY, Breast<br />
Surgery Unit, S. Orsola-Malpighi University Hospital, Bologna, ITALY,<br />
4<br />
Department of Nuclear Medicine, S. Orsola-Malpighi University Hospital,<br />
Bologna, ITALY<br />
Purpose: To evaluate 18F-2-fluoro-2-deoxy-D-glucose positron emission<br />
tomography/computed tomography (18F-FDG PET/CT) changes between<br />
baseline and after 2 cycles of PCT in pts with early/locally advanced (E/LA) BC,<br />
with <strong>the</strong> aim to verify whe<strong>the</strong>r early metabolic assessment of response during<br />
PCT may have a role in clinical practice to enable early changes in <strong>the</strong><br />
<strong>the</strong>rapeutic strategy.<br />
Patients and methods: Sixty pts with newly diagnosed E/LA BC received 6-8 cycles<br />
of anthracycline and taxane-based PCT. Fifty-eight pts underwent surgery, which<br />
consisted in breast conserving surgery or radical mastectomy; axillary node dissection<br />
was performed in all cases. Optimal pathologic response (pR) to PCT was defined as<br />
absence of cancer cells in breast and ipsilateral axillary lymph nodes. All o<strong>the</strong>r<br />
conditions were defined as nonresponders (pNR). Maximum standardized uptake<br />
value (SUV max) with 18F-FDG PET/CT was measured for each pathologic lesion at<br />
baseline and after 2 cycles of PCT. SUV max percentage changes (Δ-SUV) were<br />
compared with pR rate according to immunohistochemical (IHC) BC characteristics.<br />
Δ-SUV >50% defined a metabolic response (MetR).<br />
Results: Thirteen (22%) of 60 pts achieved pR. According to IHC, pR rates where<br />
16% in ERpositive/HER2negative (ER + /HER2-) pts, 29% and 27% in<br />
HER2-positive (HER2+) and triple negative (TN) pts respectively. Sensitivity of<br />
metR to identify pR was 100% in all three subgroups, but <strong>the</strong> specificity was low:<br />
38% in ER + /HER2- pts (38%) was <strong>the</strong> highest value. In this subgroup of pts PET<br />
had a low positive predictive value (24%), while <strong>the</strong> negative predictive value was<br />
100%, showing, compared to HER2+ and TN pts, <strong>the</strong> highest ability to correctly<br />
predict pNR (32%). At a median follow-up of 36.6 months, recurrence rate was<br />
higher in metabolic non-responders, particularly in <strong>the</strong> ER + /HER2- subgroup, in<br />
which Kaplan-Meier analysis of disease-free survival confirmed a significant<br />
difference (p = 0.0490).<br />
Conclusions: PET assay after 2 cycles of PCT correctly predicted pNR in 32% of ER<br />
+ /HER2- pts, identifying a subgroup of BC pts with worse prognosis who might<br />
benefit from an early change of <strong>the</strong> <strong>the</strong>rapeutic strategy.<br />
Disclosure: All authors have declared no conflicts of interest.<br />
363P BREAST CANCER RECURRENCES AT THE CHEST WALL<br />
(BCRCW) WHEN STANDARD TREATMENTS (TX) HAVE FAILED:<br />
LYSO-THERMOSENSITIVE LIPOSOMAL DOXORUBICIN (LTLD)<br />
+ MILD LOCAL HYPERTHERMIA (MLH)<br />
H.S. Rugo 1 , S.C. Formenti 2 , R.J. Myerson 3 , C.J. Diederich 4 , B.M. O’Connor 5 ,<br />
A.J. Matzkowitz 6 , F. Muggia 7<br />
1 Department of Medicine, University of California, San Francisco, CA, UNITED<br />
STATES OF AMERICA, 2 Radiation Oncology, NYU Langone Medical Center, NY,<br />
UNITED STATES OF AMERICA, 3 Radiation Oncology, Washington University<br />
School of Medicine in St. Louis, MO, UNITED STATES OF AMERICA, 4 Radiation<br />
Oncology, University of California, San Francisco, CA, UNITED STATES OF<br />
AMERICA, 5 Radiation Oncology, Commonwealth Atrius Cancer Center, MA,<br />
UNITED STATES OF AMERICA, 6 Radiation Oncology, Florida Cancer Specialists,<br />
New Port Richey, FL, UNITED STATES OF AMERICA, 7 Cancer Institute, NYU<br />
Langone Medical Center, New York, NY, UNITED STATES OF AMERICA<br />
Background: BCRCW has a poor prognosis, with disfigurement, pain, and<br />
restriction of movement. Study treatment consisted of LTLD that releases high<br />
concentrations of doxorubicin (Dox) in areas treated with mild hyper<strong>the</strong>rmia at ><br />
39.5°C. MLH kills tumor cells, selectively increases liposomal permeability in tumor<br />
microvasculature, releases Dox from LTLD, and promotes Dox tumor uptake.<br />
Methods: We conducted a phase I study of LTLD + MLH in patients (pts) with<br />
BCRCW tumors < 3 cm deep who had failed all standard Tx including surgery,<br />
radiation, and chemo<strong>the</strong>rapy (CTx). Pts received up to 6 LTLD/MLH Txs every 21<br />
days. Dosing cohorts started at 40 mg/m 2 and stopped escalation at 50 mg/m 2 . LTLD<br />
was infused IV over 30 minutes (min); <strong>the</strong>n MLH was given by microwave or<br />
ultrasound. The <strong>the</strong>rmal dose goal was 40°C-42°C for 60 min. Pharmacokinetic<br />
samples for total plasma Dox and doxorubicinol (Doxol) were taken at 0.5, 5, 10 and<br />
24 hours after starting infusion.<br />
Results: Eleven pts with a median of 4 prior CTx (range 2 – 12) were enrolled; 10<br />
had recurred after prior anthracycline (AC). All pts received > 2 cycles. The within<br />
subject variability in Dox and Doxol exposure was small with mean Cycle 2 vs Cycle<br />
1 ratios ranging from 0.99 to 1.06.<br />
Cmax/dose (ng/ml)/(mg/m 2 Dox<br />
)<br />
Doxol<br />
AUClast/dose ((ng*hr/ml)/(mg/m 2 ) Dox<br />
Doxol<br />
Annals of Oncology<br />
Cycle 1<br />
499.82<br />
0.46<br />
1,338.18<br />
7.96<br />
Cycle 2<br />
512.00<br />
0.45<br />
1,381.82<br />
8.04<br />
Two types of grade 3/4 toxicity were seen in > 5% of 42 cycles given: reversible<br />
neutropenia in 17 (40.5%) and reversible leukopenia in 9 (21.4%). One case (each) of<br />
mucositis (grade 1), chest wall <strong>the</strong>rmal burn, and chest wall cellulitis (both grade 4)<br />
occurred, and no cases of cardiomyopathy or hand-foot toxicity were seen. The rate<br />
of clinically significant (> 6 point) QoL improvement on <strong>the</strong> FACT-B after 2 cycles<br />
was 54.5% (95% CI: 25.1% - 83.9%), including 1 lasting > 3 months. The local<br />
objective response rate was 45.5% (95% CI: 16.1% - 74.9%), with 1 complete and 4<br />
partial local responses.<br />
Conclusion: LTLD + MLH is safe and active in BCRCW pts with prior radiation and<br />
AC exposure. A phase II study is underway.<br />
Disclosure: All authors have declared no conflicts of interest.<br />
364P IMMUNOHISTOCHEMICAL PREDICTORS OF THE CLINICAL<br />
AND PATHOLOGICAL RESPONSE TO NEOADJUVANT<br />
CHEMOTHERAPY IN LOCALLY ADVANCED BREAST CANCER<br />
M. Rodionova 1 , D. Ryabchikov 1 , S. Portnoy 2 , I. Vorotnikov 1 , N. Chkhikvadze 1<br />
1 Breast Cancer Department, N.N. Blokhin Russian Cancer Research Center,<br />
Moscow, RUSSIAN FEDERATION, 2 Department of Female Reproductive System<br />
Carcinomas, N.N.Blohkin Cancer Research Center, Moscow, RUSSIAN<br />
FEDERATION<br />
Purpose: To determine predictive immunohistochemical characteristics of <strong>the</strong> tumor<br />
correlated with <strong>the</strong> response to neoadjuvant chemo<strong>the</strong>rapy in patients with locally<br />
advanced breast cancer.<br />
Material and methods: A prospective study of 87 breast cancer patients<br />
(Т2-4N0-M0) treated in N.N.Blokhin Russian Cancer Research Center 1997 - 2009.<br />
Tumor samples were taken prior to neoadjuvant chemo<strong>the</strong>rapy (cor-biosy).<br />
Pathological criteria assessed were: histological variant, tumor grade, HR and Her-2/<br />
neu status, Ki67 expression and glycoprotein Pgp-170 status. After 4-6 cycles of<br />
chemo<strong>the</strong>rapy all <strong>the</strong> patients underwent radical surgery. We quantified <strong>the</strong> response<br />
ix130 | <strong>Abstract</strong>s Volume 23 | Supplement 9 | September <strong>2012</strong>